Barnea Y, Cohen M, Giladi M, Gur E, Greenberg R, Weiss J, Shafir R
Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Ann Plast Surg. 2000 Jul;45(1):15-8. doi: 10.1097/00000637-200045010-00003.
Grossly contaminated median sternotomy wounds are frequently treated with transposed omental flaps. A laparotomy adjacent to such an infected wound carries the risk of peritonitis. It has been suggested that this risk may increase when the omentum, which has anti-infective properties, is removed from the abdominal cavity and is transposed to the chest. The authors evaluated abdominal recovery after laparotomy and omental transposition into an adjacent, grossly contaminated median sternotomy wound. The study group included 15 patients who had sternal wound reconstruction with an omental flap between 1990 and 1998. All patients underwent median sternotomy reconstruction according to a "two-compartment" operative sequence protocol, which included division of the surgical field into an upper (thoracic) contaminated zone and a lower (abdominal) clean zone. The control group was comprised of 15 patients who underwent elective laparotomy for splenectomy during the same time period. The effect of the surgical procedure on the abdomen was compared between the two groups. The timing of the reappearance of peristalsis and regular bowel function, and the incidence of bowel obstruction and postoperative peritonitis were similar in the two groups. The findings indicate that laparotomy and omental transposition in the presence of a grossly contaminated median sternotomy wound is a safe procedure, and is associated with a low rate of abdominal complications.
严重污染的正中胸骨切开伤口常采用带蒂大网膜瓣进行治疗。在如此感染的伤口附近进行剖腹手术有发生腹膜炎的风险。有人提出，当具有抗感染特性的大网膜从腹腔中取出并转移至胸部时，这种风险可能会增加。作者评估了剖腹手术及大网膜转移至相邻严重污染的正中胸骨切开伤口后的腹部恢复情况。研究组包括15例在1990年至1998年间采用大网膜瓣进行胸骨伤口重建的患者。所有患者均按照“两腔室”手术顺序方案进行正中胸骨切开重建，该方案包括将手术区域分为上部（胸部）污染区和下部（腹部）清洁区。对照组由同期接受择期剖腹脾切除术的15例患者组成。比较了两组手术操作对腹部的影响。两组患者肠蠕动和正常肠功能恢复的时间，以及肠梗阻和术后腹膜炎的发生率相似。研究结果表明，在严重污染的正中胸骨切开伤口存在的情况下进行剖腹手术及大网膜转移是一种安全的手术，且腹部并发症发生率较低。
